Fostering Critical Thinking in Small Group OSCE Teaching Essay Answer

Teaching Philosophy

In my role as an ENT Associate Specialist, Honorary Clinical lecturer, Tutor and Educational Supervisor I teach third- year medical students observer structured clinical examination-OSCE skills They arrive at the start of the week to a dedicated teaching state of the art seminar room in University teaching hospital. The term OSCE was named by Harden (1975). My teaching philosophy is based on Kolb’s (1984) reflective cycle as it helped individuals learnt from their experiences and use that learning to improve their performance. and delivering the educational curriculum to a small group of medical students (6-8), aligning with their intended goals as described by Biggs (1963). Small group teaching is a powerful and beneficial method of delivering learning in medicine Edmund &Brown (2010). As a medical educator my philosophy for small group teaching is grounded in principles of active learning, critical thinking and collaborative problem solving. Starting with the least challenging but the most essential objective of retaining the key information covered in the session, I used both active-learning techniques and didactic repetition. The former included paired brainstorming designed to activate learning in line with ‘out of box’ Goswami et al. (2017) thinking, and all the students had to participate equally. Meo (2013) draws attention to advantage of small group teaching which I appreciated in my OSCE scenario was to achieve the goals, in the given time period of the lesson. From existing body of research of Mohanna et al. (2007), I think I fit into the ‘official formal curriculum teacher’ as I need to follow a formal curriculum. Another aspect that influences my philosophy is the OSCE session was to evaluate the practical and theoretical learning and as described by Karabilgin (2018), the session, aim at various skills integrating a combination of activities, demonstrating history taking, providing differential diagnosis the end point of communicating to the patient and making future plans for the patient. With my teaching I follow both Behavioural and Observational approaches. I could see active participation from all students allowing greater interaction and discussion of key concepts and skills, it allowed me to pay personalised attention to each student, and provide them feedback. This framework in my opinion also allows collaborative learning and team working which I could perceive however there was disengagement from a student possibly due to time management and structure and not having read the instruction. I soon overcame that barrier and role played on the station to make up the time. Overall, OSCE teaching can be valuable teaching method but it should be used with other teaching methods, to ensure a comprehensive approach to skill development and knowledge acquisition.

Description of Teaching Session

Third-year medical students who present to me at the start of every week in ‘Oncology Block (which typically lasts 8 weeks for them) and they are with us for a week came to me for this OSCE session. The Seminar room is a dedicated space with Apple Desktops and Whiteboard for student teaching. I like to introduce myself at the outset of the session and familiarize myself to the learners and try to identify their goals. In a small group setting each student has better opportunity to receive individualized attention and increased engagement Taylor& Mifflin (2008), teachers tend to be more flexible, there are improved feedback opportunities and reduced anxieties due to smaller size of class room. I based my session plan on Blooms Taxonomy -Anderson & Krathwohl (1978) as it allows me to see the learners (who are typically paired up to run the session smoothly). The setting of stations was as follows:

1. 4 Different sets of audiograms relating to different types of hearing losses.
2. 6-8 fully charged auroscopes.
3. 4 (512 Hz) tuning fork tests.
4. 4. Case based discussions with brain storming stations (two).
5. 5. Comprehensively conduct the examination of head and neck.
6. Manikin head - with ears.

In the session I incorporated active learning through pair- sharing, broader group discussions as a group with flip charts. I broke the didactic teaching for no longer than 8 minutes. The last 10 minutes were spent in a group discussion on the feedback of the session. with. if some students are absent then pairing is an issue. To summarize OSCE teaching can be an effective educational approach for improving clinical skills and knowledge where participants can benefit from increased interaction with instructors and individualised feedback.

Smart Learning Outcomes

Goal setting is an important aspect of education because it provides direction, motivating and accountability for both teachers and students. I took the opportunity to familiarize myself to the third-year student upon arrival them and then help understand their goals and interest’s, which would help increase my engagement in the session. I was hoping that by end of the teaching session the learners should be able to achieve their learning outcomes. The learning outcomes were as follows:

1. To execute the handling of auroscope and demonstrate the skill independently.
2. To demonstrate a comprehensive head and neck examination.
3. To be able to conduct tuning fork tests, evaluate and differentiate hearing losses.
4. Ability to diagnose and create a plan in Case based scenarios (2)
5. To be able to interpret audiograms, differentiate and explain as per hearing loss.

In this session I felt the session went well as students stayed motivated, goals provided by the students matched the curriculum, however I felt there were time constraints specially with the case-based scenarios needing pair and share brain storming. One of the learners lost motivation and became disengaged. Given the time constraints I tried to identify the root cause of the issue and tailored my approach. I provided a constructive feedback and highlighted her strength and suggested area of improvement. The time constraint also did not allow repeatability. Overall, while SMART objectives can be useful in many contexts, they may not be always be sufficient for the complex and dynamic OSCE teaching. It is important to consider unique needs and challenges of this form of assessment.

Educational Learning Strategyincluding Theories, Framework and Models Undepinning Your Instructional Decision- Making

Using the learning theories, in the OSCE setting medical educators can help adult learners develop knowledge and skills they need. Once I identified my third -year medical students in the setting of a dedicated seminar room for OSCE teaching, I assessed my learners needs and aligned their objectives as per their formal curriculum. In 1980 Malcolm Knowles unlocked the secret to effective adult learning with his ground-breaking Adult Learning Theory. I considered my students to be adult learners and applied both the Behavioural learning theory Gagne (1975) and Bandura’s Observational theory Fryling et al. (2011) advocated by Bandura as my scenarios demanded it. Bandura emphasized the importance of self-efficacy or a person’s belief in their ability to perform a particular task successfully. From a behaviourist perspective, learning is defined as ‘a change in human disposition or capability that persists over a period of time and is not simply ascribable to processes of growth’ (Gagne, 1985). The focus is on a new behavioural pattern being repeated until it becomes automatic. As in this theory people learn through observing, the skills of demonstrating independent auroscope handling, execute Tuning fork handling and interpreting results, Conducting the comprehensive head and neck examination and proceed to two independent case based. This concept perhaps applies well to testing theoretical knowledge pre and post-lesson. However, it may be somewhat intimidating and de-motivating when testing a skill that the learner is known to be unable to perform. Thus, pre-lesson testing was not the part of the lesson plan. Scenario discussions leading up to differentials and planning. Using the observational theory, it helped me analysing behaviours of my learners by their body language, eye contact and communication skills and hence allowed me to respond appropriately to the situation. I used the Behaviourist approach to give the feedback based on their performance, where I gave positive reinforcements to encourage candidates. Despite the use of both the theories I found that time being a constraint and in students with issues of communication skills I faced a problem as they were demotivated and faced disengagement. I used constructive feedback and looked at their positive attributes to guide them.Overall behaviourist theory and observational theories both have a place in OSCE can be useful tool in OSCE setting to assess behaviour and performance of candidates, but not without their drawbacks.

Creation of Teaching Materials

Creating teaching materials For OSCE session can be challenging but rewarding process. Once I had identified my year -three medical students. They were led to the dedicated seminar teaching room which had an Apple white board ,6 desktops and a few models of ear, head, neck, throat- both in coronal and sagittal sections. It also had very well labelled coloured anatomical charts on the wall of various parts of ENT. The room was very well lit both with natural and artificial light. The group would be working in pairs and with no definite seating plan. Seating plans can be of three types McKimm & Morris (2009). For my session I had 4 pairs of auroscopes;4 pairs of 512 Tuning forks;8 sets of Audiograms for 4 different scenarios;4 manikin heads with ears to identify ear conditions. There is also a spare long table in the room in case the students prefer to seat themselves and work as pair and share and brainstorm during case-based discussion. We had 3 boxes of gloves small medium and large, flip chart, Clinical Photographs. I chose power point as a simple resource, familiar to both me and learners but restricted to just 4 slides. I kept the text very brief, however inline with Mayer’s principle of redundancy, relying mostly on narration instead Mayer (2017). I felt that knowing the ILO, I focussed my teaching materials on lesson plan and selected the appropriate resources. one of my students lacked engagement therefore the flow was interrupted, and I pitched in as an extra to role play. Teaching materials are integral to OSCE station setup.

Delivery of Teaching

When it comes to delivering teaching in an OSCE there are several things that educators should keep in mind. My session plan was that of delivering OSCE skills to third year novice learners in a three-hour session with 6 stations. As the debrief has been discussed about the stations to ensue, the students were, upon arrival led to the stations and explained about what was to happen next with aid of previous introduction and encouraged to proceed with the station. Starting with the least challenging but the most essential objective of retaining the key information covered in the session, I used both active-learning techniques and didactic repetition. The former included paired brainstorming designed to activate learning in line with ‘out of box’ Goswami et al. (2017) thinking, and all the students had to participate equally. Meo (2013) draws attention to advantage of small group teaching which I appreciated in my OSCE scenario was to achieve the goals, (ILO’s in my case) in the given time period of the lesson. I felt the teaching was delivered in a dedicated favourable environment, with objectives set to meet their ILO’s and the session, despite my small group size and despite using 6 stations, I had to significantly reduce the breadth of didactic content covered in my session. If I were to deliver this session again I would compensate by providing a handout of the lecture slides and after session to reinforce the key learning points. Delivery of teaching in OSCE setting can be quite resource intensive requiring significant effort and time to plan.

Feedback Model(s) Used for Providing Feedback to Students

Providing feedback is an essential part of learning process. Jug et al. (2019) lists Pendleton method, Feedback sandwich and one-minute preceptor as the feedback models. In my lesson plan with OSCE session with 6 stations and paired up learners, there is a lot of pressure both with time and performance. Lara et al. (2016) advocates the environment to be favourable for feedback, timing to be close to the teacher’s observation period, and ‘specific’ feedback. My set up allowed me to construct the one-minute preceptor model as I found that to be most useful, however its limitation due to focus on a specific skill or a student needing more time with a specific skill needed more attention. Overall, while this model can be used, its limitation in OSCE set up should be recognised.

Evaluation of Teaching

Teaching is a continual process of learning and growth, and even the most experienced educators have room for improvement. I employed the Kirkpatrick’s framework Rouse(2011) and used the level 2. I chose this as I wanted my students to acquire intended knowledge and commitment. The session of 3 hours was intense, resource and time consuming, I aimed at achieving the ILO in keeping with the formal curriculum, I had a feedback sheet was in the form of a QR code and the students sent the learner feedback anonymously through ’Kahoot’ or ‘Quizlet’ anonymously back to me. There was also the option of printed handouts. This encouraged a group discussion at the end of the session (10 minutes). In my OSCE set up, the three main areas of focus were the learning experience, assessment of learning and Curriculum-whether the lesson was providing a stimulating and engaging learning experience to students? The students felt time pressured and some struggled with correlating anatomy with scenario. I were to to do this OSCE again, I would consider my session being video graphed or have a colleague to sit in and give me a feedback.

Pdp with Smart Action Items for Your Growth as a Health Professional Educator

Educational Supervision within clinical practice is essential within medical training Killminster & Jolly (2000). Alternative philosophies in medical education have affected the role of an educational supervisor (ES) being more formal with emphasis on supervisee reflection, so that a commitment to lifelong learning could be created. For this reflective, critical account I will use Gibbs reflective cycle Gibbs (1988). In description as an Honorary Clinical lecturer role, my role as an ES is to supervise foundation trainees, this involves multiple area, delivering learning needs and requirements of the supervisee Abdulla (2008). I am expected to develop trainee knowledge and critical reasoning in relation to identification, diagnosis, investigation and management of common ENT conditions. In evaluating my role as an ES, I can perceive both positive and negative areas. In positive aspects, I have been able to improve performance of trainees (especially in one failing student) by help him identify his own goals and target train him not only to the curriculum but to his own interests. My weakness as perceived by myself are those related to my educational role which will improve with time and experience/exposure. My action plan for future is to drive learning opportunities reflect and identify goals, I however need to develop knowledge and experience as an ES to improve the quality of the supervision I provide.

Conclusion

Overall, OSCE teaching can be valuable teaching method but it should be used with other teaching methods, to ensure a comprehensive approach to skill development and knowledge acquisition. It can be an effective educational approach for improving clinical skills and knowledge where participants can benefit from increased interaction with instructors and individualised feedback. Overall, while SMART objectives can be useful in many contexts, they may not be always be sufficient for the complex and dynamic OSCE teaching and it is important to consider unique needs and challenges of this form of assessment. Overall behaviourist theory and observational theories both have a place in OSCE can be useful tool to assess the behaviour and performance of candidates, but not without their drawbacks. Teaching materials are integral to OSCE station setup. Delivery of teaching can be quite resource intensive requiring significant effort and time to plan. Overall, while one-minute preceptor model can be used, its limitation in OSCE set up should be recognised. I would consider my session being video graphed or have a colleague to sit in and give me a feedback.

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